SOUTH STREET DENTAL LLC
NPI: 1821479445
· QUINCY, MA 02169
· Dentist
· NPI assigned 06/10/2015
Provider Details
| Authorized Official | BIMBLI, EMA (OWNER) |
| NPI Enumeration Date | 06/10/2015 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
383 |
$12K |
| 2019 |
100 |
$3K |
| 2020 |
39 |
$1K |
| 2022 |
49 |
$2K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
181 |
180 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
113 |
111 |
$3K |
| D4910 |
|
40 |
40 |
$3K |
| D1206 |
Topical application of fluoride varnish |
67 |
67 |
$3K |
| D1330 |
|
97 |
97 |
$1K |
| D4381 |
|
16 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
26 |
25 |
$1K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$770.00 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$254.00 |